Heart Disease
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Incidents of Female Heart Disease Examined:

Lou Henry Hoover


Hot-tempered women and heart trouble

Recently, while on vacation with my parents and 83-year-old grandmother in Florida, I did something hostile: When a party next door woke me up at 3:30 in the morning, I was so angry at being denied my sleep that I stormed over to the house (barefoot and in my pajamas, mind you), walked into the house, banged on a wall and demanded that the startled partygoers "shut the f*** up" because they were keeping my grandmother up. Despite what in retrospect was a dangerous, stupid and potentially illegal thing to have done, the tactic worked: They brought the party inside. And I later found out not only that my grandmother had slept through the entire incident but that the host of the party was a Marine.

I bring this up because of a study just published in the December issue of the Journal of Women's Health that suggests that "the outward expression of anger and hostility is higher in certain women with suspected coronary artery disease," according to this press release (PDF). Uh-oh.

But before I allow myself to get too concerned that, at 28, expressing justified anger is going to lead to a heart attack at 30, here are some clarifying points: First, this study, which was part of the much larger Women's Ischemia Syndrome Evaluation (WISE) study sponsored by the National Heart, Blood and Lung Institute, was a cross-sectional attempt to help better understand heart disease by gender. Kudos to that -- most single-gender research into heart disease has focused on men (think, for example, of the Physicians' Health Trial and the Multiple Risk Factor Intervention Trial [MRFIT]). Second, the study findings aren't suggesting that women should try to suppress their outward expressions of anger, which headlines like this one ("Women's Expressed Anger May Hurt Heart") make it seem as if they are. The study does say in its press release that "women who outwardly express anger may be at increased risk if they also have any of several other risk factors: age (risk increases as women get older), history of diabetes and history of unhealthy levels of fats (lipids) in the blood." Nor is it asserting that women who express their anger are at greater risk of CAD than men who express anger; rather, previous studies have shown a link between men's anger (suppressed, expressed and general hostility) and heart disease.

The paper does say that in the group of women studied, all of whom had been referred for angiographs by their doctors because of suspected CAD, there was a link between expressed anger and CAD. And what's more, women with high levels of expressed anger were more likely to be showing cardiac symptoms, even if their angiographs didn't show CAD itself. Unfortunately, according to one of the study's authors, it's impossible to determine the cause and effect here -- does outwardly expressed anger cause cardiac symptoms? Or are anger and frustration the result of having undiagnosed symptoms? (As the study puts it, "The relationship between symptoms and emotion in the WISE sample may reflect frustration and anger resulting from not having a definitive diagnosis or treatment for chest pain symptoms.") Hopefully, further studies will investigate this.

According Dr. David Krantz, lead author of the study and professor and chairman of medical psychology at Uniformed Services University, it's also important to note that men and women show their anger differently -- so if it's true that anger is related to heart disease, we'd better figure out how to identify and treat anger in women. As he explained to Broadsheet, "anger and hostility are different in men and women because our culture makes certain types of behaviors more acceptable than others [by gender] -- for example, women might be more verbal and men might be more physical. If you do an intervention directed at men's anger it likely would be misdirected when done for women because it would solve the men's version of anger."

There's still more investigation to be done. But my bigger point is this: Many news headlines are making it seem as if when a woman gets pissed off and, oh, I don't know, breaks into a Marine's house, she's putting herself at greater risk of coronary artery disease than a man would have, just because she expressed her anger. But the study's actual results are far more subtle.

-- Catherine Price

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